title: 'Do it yourself' sexual health care: the user experience.
abstract: OBJECTIVE
  To describe client experience of self-management within a busy walk-in, sexual health service. Self-management in this context is self-registration and take-home pregnancy tests, chlamydia (Chlamydia trachomatis) and gonorrhoea (Neisseria gonorrhoeae) tests, or condoms dispensed from a free vending machine.
  
  
  METHODS
  Twenty-four in-depth, semi-structured interviews with users; 19 structured written reports from mystery shoppers paid to visit the service and report their experience; demographic details of those using the self-management option from the clinic database and 40 h of recorded observation in the clinic waiting room.
  
  
  RESULTS
  Between 2 September 2008 and 1 September 2009, 18 657 people had 28 545 attendances at the service. Of these, 1845 (6.5%) attendances were self-managed by 1555 individuals (8.3% of all clients). Of those who self-managed, 646 (35%) obtained a chlamydia and gonorrhoea test only, 597 (32%) obtained condoms only and 488 (27%) obtained a pregnancy test only. Users valued the opportunity to self-manage because of the reduced waiting times, autonomy and privacy that such a service offers. Some prefer the additional support offered within a clinical consultation. Users made personalised decisions about self-management based on time pressure, need for additional services and preferred source of support. Users often required help and advice from client support workers to complete the self-management process. This created problems with confidentiality.
  
  
  CONCLUSIONS
  Self-management is an acceptable option within sexual health services if informal support is available. Self-management options in clinical services could mean that 8% of clients at 6% of visits do not need to see a clinician, thus freeing up clinical capacity.
authors.affiliation: Camberwell Sexual Health Centre, London SE5 9RS, UK. Paula.Baraitser@nhs.net
authors.forename: Paula
authors.initials: P
authors.lastname: Baraitser
authors.forename: Kirsty Collander
authors.initials: KC
authors.lastname: Brown
authors.forename: Zachary
authors.initials: Z
authors.lastname: Gleisner
authors.forename: Vikki
authors.initials: V
authors.lastname: Pearce
authors.forename: Usha
authors.initials: U
authors.lastname: Kumar
authors.forename: Michael
authors.initials: M
authors.lastname: Brady
mesh_terms: D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D002690:Chlamydia Infections / Q000517:prevention & control*; D017280:Condoms / Q000706:statistics & numerical data; D006069:Gonorrhea / Q000517:prevention & control*; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008131:London / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D012648:Self Care / Q000706:statistics & numerical data*; D020377:Self Efficacy; D013222:State Medicine / Q000458:organization & administration